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Several studies have demonstrated that medical students and doctors rank specialties differently in terms of perceived status and prestige. At the same time some of the specialties have problems with recruiting and retaining staff. This study aimed to understand what constitutes status and prestige in the medical field and how it influences medical doctors' choice of specialty. By using a sociological perspective and applying Bourdieu's theoretical concepts of field, symbolic capital and perceived status, we analysed young doctors' journeys towards their chosen specialty. We conducted 15 in-depth semi-structured interviews. The data was analysed using content analysis. The findings suggest that medical specialties carry different social status. In the field of power, surgery is seen as the most prestigious of all specialties. However, in the future it might be a less attractive choice when young doctors tend to view their profession less as an identity and more like a job. For specialties perceived as low status, the challenge is to raise popularity by better describing to young doctors the characteristics and advantages of these specialties.

The aim of this study was to explore challenging encounters experienced by registered nurses (RN) during their first year in the emergency medical service by using the social learning theory of communities of practice. During the first year in a new professional practice, a new RN experiences a transition during which the new professional identity is being formed. This is a challenging and demanding period of time. According to the learning theory of communities of practice by Lave and Wenger, individuals' learning and development in a new professional practice occurs through participation in social activity and is influenced by context. This study is based on the qualitative data from semi-structured interviews. Thirty-two RNs working in the Swedish emergency medical service were interviewed via telephone during the spring of 2017. A qualitative content analysis with deductive reasoning of the interviews was used. The analysis process generated the main category; "New RNs participation is challenged by unpredictability and uncertainty in practice." The main category was based on three generic categories; "Loneliness in an unpredictable context," "Uncertainty about the team," and "Uncertainty in action." The challenges new RNs encounter during the first year relate to all three dimensions of a community of practice; mutual engagement, joint enterprise and shared repertoire. The encountered challenges also relate to the EMS context. Taking into account all these aspects when designing support models for RN's professional development may be advantageous for creating positive development for RNs new to the EMS and/or similar practices.

In basketball, game-related statistics are the most common measure of performance. However, the literature assessing their reliability is scarce. Purpose: Analyze the number of games required to obtain a good relative and absolute reliability of teams' game-related statistics. Method: A total of 884 games from the 2015-2016 to 2017-2018 seasons of the Spanish men's professional league were analyzed using all games and clustered by scoring difference. Intra-class correlation coefficient (ICC) was calculated for each variable. The number of games required to detect a change and to achieve good relative reliability was calculated using minimal detectable change and Spearman-Brown prophecy formula respectively. Results: Using all games, the results showed that the minimal number of games required in each group was 30 to detect a medium change (d > 0.5), 187 for a small change (d > 0.2), and 100 for good relative reliability (ICC = 0.75). Using balanced and unbalanced games, the minimal number of games required in each group was respectively 31 and 30 to detect a medium change (d > 0.5), 190 and 188 for a small change (d > 0.2), and 191 and 121 for good relative reliability (ICC = 0.75). Conclusions: The sample needs to consist of at least 30 games in each group to detect a medium size change, and at least 190 games to detect a small size change. To be able to rank teams with good reliability, at least 100 games are required when including both balanced and unbalanced games.

Objective To examine interrelations between care-related burden on informal caregivers and their proxy assessments of outcomes in people without natural speech.Design A cross-sectional survey.Setting Data were collected in January 2019 from a postal survey of informal caregivers of people without natural speech who are insured by a large regional health insurance company in the German federal state of Lower Saxony.Participants n=714 informal caregivers of people without natural speech of all ages and with various underlying disabilities were identified and contacted via the health insurance company. Data from n=165 informal caregivers (26.4%) were obtained.Main outcome measures Caregiver burden (self-reported, Burden Scale for Family Caregivers), pragmatic communication skills of people without natural speech (proxy report, self-developed), health-related quality of life of people without natural speech (proxy report, DISABKIDS Chronic Generic Measure - DCGM-12) and functioning of people without natural speech (proxy report, WHO Disability Assessment Schedule 2.0).Results The analyses revealed significant associations between caregiver burden on the one hand and both proxy-reported health-related quality of life (b=−0.422; p≤0.001) and functioning (b=0.521; p≤0.001) on the other. Adding caregiver burden to the regression model leads to a substantial increase in explained variance in functioning (R² Model 1=0.349; R² Model 2=0.575) as well as in health-related quality of life (R² Model 1=0.292; R² Model 2=0.460).Conclusions Caregiver burden should be considered an important determinant when informal caregivers report outcomes on behalf of people without natural speech. Longitudinal studies are recommended to better understand the burdens experienced by caregivers when supporting people without natural speech.Trial registration number DRKS00013628.

An object-based method for automatic iceberg detection has been applied to Advanced Synthetic Aperture Radar images in the Amundsen Sea Embayment (ASE), Antarctica. The images were acquired between 1 January 2006 and 8 April 2012 under varying meteorological, oceanographic and sea-ice conditions. During this time period, the icebergs were counted (average 1370 ± 50) and their surface area was estimated (average 1537.5 km2). The average surface area was about 2.5 times larger than the annual calved area (620 km2), indicating that the average iceberg age in the ASE is about 2.5 years, which was confirmed by observed residence times based on drift tracks. Most of the ASE icebergs were less than 1500 m long, and almost 90% of them were smaller than 2 km2. The proportion of small- and medium-sized icebergs (84.4%) was significantly higher than in the open ocean, where large icebergs (>10 km2) account for nearly the whole iceberg surface area. The opposite was true for the freshly calved icebergs in the ASE. The data indicate that the creation of icebergs in the ASE is dominated by steady small- to medium-scale calving from ice shelves fringing the embayment. In addition, rare calving events of giant icebergs occur on a decadal timescale. There is also some import of icebergs from the Bellingshausen Sea further east along the coast, in particular after large calving events there.

I simulated selective harvest strategies of moose (Alces alces) using antler point restrictions and protection of cows with calves to assess the impact of these strategies on population age structure and potential harvest efficiency (proportion of allowed shooting opportunities). The post-hunt, adult bull:cow ratio was held constant throughout the simulations, but age structure of the bull cohort was allowed to vary. The simulation showed that protecting bulls with few antler points (

Abstract Background New and inexperienced emergency medical service (EMS) professionals lack important experience. To prevent medical errors and improve retention there is an urgent need to identify ways to support new professionals during their first year in the EMS. Methods A purposeful sample and snowball technique was used and generated a panel of 32 registered nurses with 12–48 months of EMS experience. A Delphi technique in four rounds was used. Telephone interviews were undertaken in round one to identify what desirable support professionals new to the EMS desire during their first year. Content analysis of the transcribed interviews yielded items which were developed into a questionnaire. The experts graded each item in terms of perceived importance on a 5-graded likert scale. Consensus level was set at 75%. Items which reached consensus were removed from questionnaires used in subsequent rounds. Results Desirable support was categorized into eight areas: Support from practical skills exercises, support from theoretical knowledge, support from experiences based knowledge, theoretical support, support from an introduction period, support from colleagues and work environment, support from management and organization and other support. The experts agree on the level of importance on 64 of a total of 70 items regarding desirable support. One item was considered not important, graded 1 or 2, 63 items were considered important, graded 4 or 5. Conclusion Even with extensive formal competence the EMS context poses challenges where a wide variety of desirable forms of support is needed. Support structures should address both personal and professional levels and be EMS context oriented.

The aim of this study was to examine how the introduction of the VAR system influenced the play in elite soccer. The sample consists of 1024 matches played in the Italian Serie A and the German Bundesliga league during the seasons before and after the implementation of the VAR system. The following variables were recorded for each match: Fouls, Goals, Offsides, Penalties, Playing time in the first half, Playing time in the second half, Total Playing time, Red cards and Yellow cards. Match statistics were retrieved from the website of "Whoscored" (). A generalized linear model and a pairwise z-tests were used to compare seasons before and after the implementation of the VAR. There was a decrease in the number of offsides, fouls and yellow cards after the implementation of the VAR. Meanwhile, there was an increase in the number of minutes added to the playing time in the first half and the full game, but not in the second half. These findings may help coaches, players and managers to better understand the effects of the VAR system on professional soccer and to identify strategies to improve refereeing during matches. [ABSTRACT FROM AUTHOR]

Abstract Introduction Health disparities arise from biological‐environmental interactions. Neuroimaging cohorts are reaching sufficiently large sample sizes such that analyses could evaluate how the environment affects the brain. We present a practical guide for applying geospatial methods to a neuroimaging cohort. Methods We estimated brain age gap (BAG) from structural magnetic resonance imaging (MRI) from 239 city‐dwelling participants in St. Louis, Missouri. We compared these participants to population‐level estimates from the American Community Survey (ACS). We used geospatial analysis to identify neighborhoods associated with patterns of altered brain structure. We also evaluated the relationship between Area Deprivation Index (ADI) and BAG. Results We identify areas in St. Louis, Missouri that were significantly associated with higher BAG from a spatially representative cohort. We provide replication code. Conclusion We observe a relationship between neighborhoods and brain health, which suggests that neighborhood‐based interventions could be appropriate. We encourage other studies to geocode participant information to evaluate biological‐environmental interaction.

Summary: Neuronal hyperactivity induces memory deficits in Alzheimer’s disease. However, how hyperactivity disrupts memory is unclear. Using in vivo synaptic imaging in the mouse visual cortex, we show that structural excitatory-inhibitory synapse imbalance in the apical dendrites favors hyperactivity in early amyloidosis. Consistent with this, natural images elicit neuronal hyperactivity in these mice. Compensatory changes that maintain activity homeostasis disrupt functional connectivity and increase population sparseness such that a small fraction of neurons dominates population activity. These properties reduce the selectivity of neural response to natural images and render visual recognition memory vulnerable to interference. Deprivation of non-specific visual experiences improves the neural representation and behavioral expression of visual familiarity. In contrast, in non-pathological conditions, deprivation of non-specific visual experiences induces disinhibition, increases excitability, and disrupts visual familiarity. We show that disrupted familiarity occurs when the fraction of high-responsive neurons and the persistence of neural representation of a memory-associated stimulus are not constrained.